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Evolving Treatment Strategies for Gallbladder Cancer

  • Hepatobiliary and Pancreatic Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Gallbladder cancer is an uncommon cancer that has traditionally been associated with a poor prognosis. In the era of laparoscopic cholecystectomy, incidental gallbladder cancer has dramatically increased and now constitutes the major way patients present with gallbladder cancer. While patients with incidental gallbladder cancer have a better survival than patients with nonincidental gallbladder cancer, incidental gallbladder cancer can be associated with a varied prognosis. Imaging with computed tomography (CT), magnetic resonance imaging (MRI), and [18]F-fluorodeoxyglucose (FDG) positron emission tomography (PET), as well as diagnostic laparoscopy, all have varying roles in the workup of patients with incidental gallbladder cancer. For patients with T1b, T2, and T3 incidental gallbladder cancer re-resection is generally recommended. At re-exploration, many patients with incidental gallbladder cancer will have residual disease. Definitive oncologic management requires re-resection of the liver, portal lymphadenectomy, and attention to the common bile duct. The extent of the hepatic resection should be dictated by the ability to achieve a microscopically negative (R0) margin. Routine resection of the common bile duct is unnecessary but should be undertaken in the setting of a positive cystic duct margin. If an incidental gallbladder cancer is discovered at the time of surgery, whether the surgeon should directly proceed with a more definitive oncologic operation should depend on the surgeon’s skill-set and experience. Gallbladder cancer has a propensity to recur. Although data for adjuvant therapy following resection are limited, some data do suggest a survival benefit for adjuvant chemoradiation therapy. Management of patients with gallbladder cancer requires a multidisciplinary approach with input from a surgeon skilled in hepatobiliary surgery.

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Acknowledgment

Dr. Pawlik is supported by Grant Number 1KL2RR025006-01 from the National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH), and NIH Roadmap for Medical Research. The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official view of NCRR or NIH.

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  1. Departments of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Matthew T. Hueman MD & Timothy M. Pawlik MD, MPH

  2. Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA

    Charles M. Vollmer Jr. MD

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  1. Matthew T. Hueman MD
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  2. Charles M. Vollmer Jr. MD
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  3. Timothy M. Pawlik MD, MPH
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Correspondence to Timothy M. Pawlik MD, MPH.

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Hueman, M.T., Vollmer, C.M. & Pawlik, T.M. Evolving Treatment Strategies for Gallbladder Cancer. Ann Surg Oncol 16, 2101–2115 (2009). https://doi.org/10.1245/s10434-009-0538-x

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